Tracheal development after left pulmonary artery reimplantation: an individual study

Abstract

Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

Incidence of congenital tracheal stenosis in left pulmonary artery sling diagnosed by bronchoscopy

“…This rate is a signi cant deviation from those in previous reports. For several decades, the incidence of CTS in patients with LPAS has been reported to range from 50-65% [4,6,12]. However, those exact percentages were not described in the cited literatures [1,2].…”

A Delayed Anatomic Diagnosis and Management Challenge in an Initially Asymptomatic Infant With Type II Pulmonary Artery Sling: A Case Report

“…Most authors suggest that LPA reimplantation plus simultaneous tracheoplasty should be performed in patients presenting moderate or more severe clinical symptoms ( 19 – 21 ). Conversely, there is a growing number of reports showing that LPA reimplantation without tracheoplasty confers good outcomes even in severe cases ( 4 , 5 , 22 ). Indeed, it is difficult to predict, before surgery, if the respiratory symptoms in patients with PAS and congenital tracheal stenosis (CTS) have to be ascribed to one, the other or, to the combination of both.…”

“…However, no consensus on the intervention timing and treatment strategy for asymptomatic and mild cases has been reached. Regular follow-up for asymptomatic and mild cases is advocated by most centers due to the relatively encouraging results with conservative management and the evidence of increased risk regarding postoperative death or complications ( 4 , 5 ).…”

Pulmonary artery sling: An overview

“…Following slide tracheoplasty, the trachea usually grows with age with no limitations on exercise later in childhood or adulthood. 60 At the more complex end of the spectrum there may be associated tracheobronchial malacia which may be approached by a number of ways including long-term ventilation or airway stenting, more recently with biodegradable stents. 6,43,61 Other postoperative complications include anastomotic leak and granulation tissue at the incision site.…”

“…Typically, patients are ventilated for a few days to allow the tracheal sutures to heal and then the patient may require multiple balloon dilations in the ensuing 12−24 months at increasingly less frequent intervals. Following slide tracheoplasty, the trachea usually grows with age with no limitations on exercise later in childhood or adulthood 60 . At the more complex end of the spectrum there may be associated tracheobronchial malacia which may be approached by a number of ways including long‐term ventilation or airway stenting, more recently with biodegradable stents 6,43,61 …”